Joint Commission Opens Goals Clarifications for Public Input

The times, they are a-changing. For years the accreditation world has come to expect a treat every summer: new and revised National Patient Safety Goals from The Joint Commission.

In theory, the NPSGs are regarded as a good and necessary concept, improving patient safety across the country and targeting challenging areas—but, constantly evolving, updated, added to, subtracted from, the NPSGs have presented a particularly frustrating challenge for accreditation coordinators.

In recent months, The Joint Commission has taken a different tactic with the NPSGs and looked at them with a fresh eye. Earlier, the organization announced that there would be no new goals in 2009—a breather of sorts—while the existing goals would be examined to see if they were working.

In February 2009, The Joint Commission announced that it would not factor survey findings on NPSG 8, medication reconciliation, into the organization's accreditation decision nor would these findings generate Requirements for Improvement or appear on its accreditation report, as The Joint Commission was reexamining the goal to "evaluate and refine the expectations for accredited organizations," according to an official statement.

At the time, speculation pointed to Universal Protocol that would soon receive similar treatment. As it turns out, the speculators were right: The Joint Commission has asked the field to review and comment on revisions to the 2009 NPSGs and 2009 Universal Protocol as part of this ongoing project to improve the NPSGs.

The Joint Commission has crafted revisions in the hopes of clarifying language and increasing relevancy to the settings where they are applied. Twenty-one pages of proposed revisions have been posted to The Joint Commission's Web site identifying standards and Elements of Performance proposed for revision or deletion.

"The proposed changes to critical results is more manageable," says Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor. "The most problematic standards have been medication reconciliation and Universal Protocol—The Joint Commission took action on medication reconciliation in February, and we anticipate more changes to medication reconciliation and Universal Protocol on the horizon. In short, the changes are good—they've deleted a lot and made the goals easier to follow."

Feedback will be gathered over a six-week period beginning May 12. Among the proposed changes: Eight NPSGs would be moved into the standards with some or all of their existing Elements of Performance. Ten others (including Universal Protocol) remain under the goals.

"There's a lot of movement from the NPSGs to the standards," says Di Giacomo-Geffers. "Some requirements are retained as NPSGs, some deleted, some moved to the standards… all have some rewording to be made simpler and more clear."

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